Provider Demographics
NPI:1679057244
Name:ANNAPURNA COUNSELING, LLC
Entity Type:Organization
Organization Name:ANNAPURNA COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:UNCIL
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:JO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-850-0442
Mailing Address - Street 1:11491 W WAGON PASS CT
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-8565
Mailing Address - Country:US
Mailing Address - Phone:208-850-0442
Mailing Address - Fax:208-549-5833
Practice Address - Street 1:7669 W RIVERSIDE DR STE 101
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-6183
Practice Address - Country:US
Practice Address - Phone:208-850-0442
Practice Address - Fax:208-549-5833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty